Rectal Prolapse

Question 1

What is a rectal prolapse?

1 - haemorrhoids protrude out past the anus
2 - anal columns protrude out past the anus
3 - anal canal protrudes out past the anus
4 - pelvic floor muscles protrude out of the anus

Answer 1

3 - anal canal protrudes out past the anus

• a full thickness protrusion of the rectal wall beyond the anus
• the rectum passes through the pelvic floor, taking with it the mucosa and muscles through the anal canal

Question 2

How common is rectal prolapse?

1 - 0.25 / 100,000
2 - 2.5 / 100,000
3 - 25 / 100,000
4 - 250 / 100,000

Answer 2

2 - 2.5 / 100,000

Question 3

Is a rectal prolapse more common in men or women?

Answer 3

• women, generally of older age

Question 4

Which of the following is NOT a common risk factor for rectal prolapse?

1 - age
2 - alcohol
3 - obstetrics trauma
4 - multiple vaginal deliveries
4 - straining of stool

Answer 4

2 - alcohol

Question 5

Can children get a rectal prolapse?

Answer 5

• yes
• generally occurs around the age of 2, due to straining
• can be placed back inside and be fine afterwards

Question 6

In elderly patients who have a rectal prolapse, when does a rectal prolapse generally occur?

1 - when urge to pass stool
2 - when passing urine
3 - when trying to contract external sphincter
4 - when passing stool

Answer 6

4 - when passing stool

• prolapse normally retracts spontaneously
• prolapse can be manually returned manually with little complications

Question 7

In an elderly patient whose prolapse will not retract, this means it is becoming worse and the prolapse may occur when the patient just stands up. What 2 does this commonly lead to?

1 - incontinence and blood loss
2 - incontinence and social isolation
3 - blood loss and social isolation
4 - incontinence and pain

Answer 7

2 - incontinence and social isolation

• incontinence occurs due to dilation of the internal sphincter
• social isolation occurs as the patient cannot control bowels anymore so doesn’t leave home
• BLEEDING CAN ALSO OCCUR AT TIMES

Question 8

If a patient has a significant prolapse, in addition to incontinence and social isolation, patients can can present with additional symptoms. Which of the following is not common?

1 - pain
2 - constipation
3 - anal fistula
4 - discharge of mucus or rectal bleeding

Answer 8

3 - anal fistula

Question 9

If conservative management of rectal prolapse has failed, such as manual retraction, analgesias, reduction of risk factors, then surgery is often required. Is a surgical or perianal approach more effextive?

Answer 9

• roughly the same effectiveness
• both have a recurrence of aprox 30%

Question 10

When need to operate surgically on a patient there is little difference in the outcomes of an abdominal or perianal approach. However, in an older or unfit patient, which approach would be most appropriate?

Answer 10

perianal approach
- regional block is safer for the patient

Question 11

In the abdominal laparoscopic approach, re-organise the steps as to what generally occurs during surgery?

1 - mesorectum is sutured to the sacral promontory and presacral fascia
2 - prolapse is reduced
3 - rectum is mobilised

Answer 11

1 - prolapse is reduced
2 - rectum is mobilised
3 - mesorectum is sutured to the sacral promontory and presacral fascia

• can often removed redundant sigmoid to reduce constipation

Question 12

In the perianal approach, re-organise the steps as to what generally occurs during surgery?

1- plicating the rectal wall
2 - resection of redundant rectal mucosa of prolapse
3 - replace prolapsed rectum

Answer 12

1 - resection of redundant rectal mucosa of prolapse
2 - plicating the rectal wall
3 - replace prolapsed rectum

Question 13

What is the most common perinal approach used to surgically manage a rectal prolapse called?

1 - Delormes
2 - Altemeiers
3 - Hartmans
4 - roux-en-y

Answer 13

1 - Delormes